COMMITTEE SUBSTITUTE
FOR
H. B. 4299
(By Mr. Speaker, Mr. Kiss, and Delegates Martin, Compton,
Leach, Douglas, Staton and Capito)
(Originating in the Committee on Finance)
[February 25, 1998]
A BILL to amend chapter five of the code of West Virginia, one
thousand nine hundred thirty-one, as amended, by adding
thereto a new article, designated article sixteen-b; to
amend and reenact section two-b, article four-a, chapter
nine of said code; and to further amend said article by
adding thereto a new section, designated section three, all
relating to creating a children's health care inclusion
program; expanding access to health services to certain
eligible children; requiring reporting; creating a
children's health care inclusion program board, specifying
membership and qualifications of members, compensation and
expenses, powers and duties; providing for employment of a
director, authorizing contracts, providing for powers and
duties; providing for preparation of state plan through
interagency cooperation; creating a special revolving fund
known as the West Virginia CHIP fund; providing guidelines
to be considered by the board and director in developing and
planning the program; adopting provisions of federal law relating to state programs; providing for termination and
reauthorization; expanding medicaid coverage to certain
eligible children; and creating a special revolving fund
known as the West Virginia mini-CHIP fund.
Be it enacted by the Legislature of West Virginia:
That chapter five of the code of West Virginia, one thousand
nine hundred thirty-one, as amended, be amended by adding thereto
a new article, designated article sixteen-b; that section two-b,
article four-a
, chapter nine of said code be amended and
reenacted; and that said article be further amended by adding
thereto a new section, designated section three, all to read as
follows:
CHAPTER 5. GENERAL POWERS AND AUTHORITY OF THE GOVERNOR,
SECRETARY OF STATE AND ATTORNEY GENERAL; BOARD OF PUBLIC
WORKS; MISCELLANEOUS AGENCIES, COMMISSIONS, OFFICES,
PROGRAMS, ETC.
ARTICLE 16B. WEST VIRGINIA CHILDREN'S HEALTH CARE INCLUSION
PROGRAM.
§5-16B-1. Expansion of health care coverage to children;
creation of program; legislative directives.
(a) It is the intent of the Legislature to expand access to
health services for eligible children and to pay for this
coverage by using private, state and federal funds to purchase
those services or purchase insurance coverage for those services.
To achieve this intention, the West Virginia children's health
care inclusion program is hereby created. The program shall be
administered by the bureau of medical services of the department of health and human services in accordance with the provisions of
this article and the applicable provisions of Title XXI of the
Social Security Act of 1997. Participation in the program may be
made available to families of eligible children, subject to
eligibility criteria and processes to be established, which shall
not create an entitlement to coverage in any person. Nothing in
this article may be construed to require any appropriation of
state general revenue funds for the payment of any benefit
provided for in this article. In the event that this article
conflicts with the requirements of federal law, federal law shall
govern.
(b) In developing benefit plans, the board may consider any
cost savings, administrative efficiency or other benefit to be
gained by considering existing contracts for services with state
health plans and negotiating modifications of those contracts to
meet the needs of the program.
(c) In developing a children's health program that operates
with the highest degree of simplicity and governmental
efficiency, the board shall avoid duplicating functions available
in existing agencies and enter into interagency agreements for
the performance of specific tasks or duties at a specific or
maximum contract price.
(d) The population covered under the program is limited to
children up to their nineteenth birthday, who are not covered
under any health insurance plan, who are not eligible for
coverage under a group health insurance plan available to a
parent or guardian, and who are not medicaid-eligible or medicare-eligible. For purposes of eligibility determination, a
COBRA policy, as defined in chapter thirty-three of this code, is
not a group-sponsored plan available to a parent or guardian. In
no case shall insurance provided by the program be other than
primary coverage.
(e) On the first day of January, one thousand nine hundred
ninety-nine and annually thereafter, the director shall report to
the governor and the Legislature regarding the number of children
enrolled in the program or programs; the average annual cost per
child per program; the number of children enrolled in Medicaid,
the public employees insurance agency and private sector
insurance programs; the number of remaining uninsured children;
and the effectiveness of the outreach activities for the previous
year. The report shall include any information that can be
obtained regarding the prior insurance and health status of the
children enrolled in programs created pursuant to this article.
Beginning with the second annual report, the director shall
include information regarding the cost, quality and effectiveness
of the health care delivered to enrollees of this program;
satisfaction surveys; and health status improvement indicators.
The board, in conjunction with other state health and insurance
agencies, shall develop indicators designed to measure the
quality and effectiveness of children's health care inclusion
programs, which information shall be included in the annual
report.
(f) Implementation of the program shall be reported
quarterly to the legislative oversight commission on health and human resources accountability. The report shall include, but
not be limited to, the number of covered children, by age,
served, statistical profiles of the families served, health
status indicators of covered children, the average annual cost of
coverage per child and the total cost of all children served by
provider type.
§5-16B-2. Definitions.
As used in this article, unless the context clearly requires
a different meaning:
(a) "Benchmark plan" means the insurance benefit plan
currently offered within the state that meets requirements of
applicable federal law and is identified by the board as the
benefit plan that will be used in determining the minimum
aggregate actuarial value and targeted maximum actuarial value
for benefits provided under a children's health insurance program
in this state. The "benchmark plan" may also serve to set the
minimum level of pharmacy, mental health or other specified
services that may under applicable federal law be provided under
a children's health insurance program. Selection of a benefit
plan as the "benchmark plan" does not serve as an indicator of
who will be awarded contracts or participate in administering a
children's health care inclusion program.
(b) "Benchmark-equivalent plan" means the benefit plan,
designed to serve the unique health care needs of children, that
is at least actuarially equivalent to the plan selected by the
board as the benchmark plan, that the board develops and approves
after considering the
goals and objectives for a children's health insurance program
presented by the governor and the
guidelines for the program set forth in this article.
(c) "Board" means the children's health care inclusion
program board;
(d) "Director" means the director of the children's health
care inclusion program;
(e) "Program" means the West Virginia children's health
care inclusion program.
§5-16B-3. Children's health care inclusion program board
created; qualifications and removal of members; powers;
duties; meetings; and compensation.
(a) There is hereby created the West Virginia children's
health care inclusion program board, which shall consist of the
director of the public employees insurance agency, the secretary
of the department of health and human resources or his or her
designee, and five citizen members appointed by the governor, one
of whom shall be an advocate of childrens' interests, to assume
the duties of the office immediately upon appointment pending the
advice and consent of the senate. Of the citizen members first
appointed, one shall serve one year, two shall serve two years
and two shall serve three years. All future appointments shall
be for terms of three years, except that an appointment to fill
a vacancy shall be for the unexpired term only. Four of the
citizen members shall have at least a bachelor's degree and
experience in the administration or design of public or private
employee or group benefit programs and the advocate shall have
experience that demonstrates knowledge in the health, educational and social needs of children. No more than three citizen members
may be members of the same political party. A lobbyist
registered pursuant to chapter six-b of this code, a person
representing the interests of a health care network or private
insurer reasonably expected to compete for contracts under this
article, or a private provider of health care services reasonably
expected to receive reimbursement for health care services
pursuant to this article may not serve on the board. All members
of the board shall assume the duties of the office immediately
upon appointment and shall meet not later than the thirtieth day
of April, one thousand nine hundred ninety-eight. The members
shall elect a chairperson. No member may be removed from office
by the governor except for official misconduct, incompetence,
neglect of duty, neglect of fiduciary duty or other specific
responsibility imposed by this article, or gross immorality.
Vacancies in the board shall be filled in the same manner as the
original appointment.
(b) The purpose of the board is to develop plans for health
services or health insurance that are specific to the needs of
children; and, to bring fiscal stability to this program through
development of an annual financial plan designed in accordance
with the provisions of this article.
(c) The board shall design the children's health care
inclusion program, which shall reflect the most essential health
care needs of children and, notwithstanding any other provisions
of this code to the contrary, is exempt from the minimum benefits
and coverage requirements of articles fifteen and sixteen, chapter thirty-three of this code.
(d) The board shall develop the strategic objectives,
performance goals and performance measures in accordance with the
requirements of the Social Security Act of 1997 and is
responsible for meeting all evaluation and reporting requirements
required by that act.
(e) In cooperation with other state agencies, the board is
to develop and coordinate the outreach, screening and enrollment
activities; devise an application process and eligibility
standards that provide the highest possible degree of
administrative simplicity, in obtaining identifying information;
in determining income status; in developing a statistical profile
of the population served;
and in obtaining such other information
required by applicable federal law or determined to be essential.
(f) The board may consider adopting the maximum period of
continuous eligibility permitted by applicable federal law
,
regardless of changes in a family's economic status, so long as
other group insurance does not become available to a covered
child.
(g) The board shall conduct one or more public hearings in
each congressional district to afford interested and affected
persons an opportunity to offer comment on the benefit and
financial plan.
(h) The board shall meet at the time and place as specified
by the call of the chairperson or upon the written request to the
chairperson by at least two members. Notice of each meeting
shall be given in writing to each member by the chairperson at least three days in advance of the meeting. Five members shall
constitute a quorum. The board may convene advisory committees
as needed to develop benefit or financial plans as required by
this article.
(i) The board shall pay each of the citizen members
appointed by the governor the same compensation and expense
reimbursement as is paid to members of the Legislature for their
interim duties as recommended by the citizens legislative
compensation commission and authorized by law for each day or
portion thereof engaged in the discharge of official duties.
§5-16B-4. Director of the children's health insurance program;
qualifications; powers and duties.
(a) The board shall employ a director with at least a
bachelor's degree and at least three years experience in health
insurance administration to serve at the will and pleasure of the
board. The director is the chief administrative officer of the
program.
(b) The director shall employ any administrative, technical
and clerical employees as are required for the proper
administration of the program and for the work of the board. The
director shall present recommendations and alternatives for the
design of the initial and annual plans, and other actions
undertaken by the board in furtherance of this article.
(c) The director, under the supervision of the board, is
responsible for the administration and management of the program
and shall have the power and authority to make all rules
necessary to effectuate the provisions of this article. Nothing in this article shall limit the director's ability to manage the
program on a day-to-day basis, including, but not limited to,
administrative contracting; studies, analyses and audits;
utilization management provisions and incentives; provider
negotiations, provider contracting and payment; designation of
covered and noncovered services; offering of additional coverage
options or cost containment incentives; pursuit of coordination
of benefits and subrogation; or any other actions which would
serve to implement the plan or plans designed by the board.
(d) The director of the program shall have exclusive
authorization to execute such contract or contracts as are
necessary, including contracts with insurers or health care
networks that meet standards and qualifications approved by the
board. The provisions of article three, chapter five-a of this
code, relating to the division of purchases of the department of
finance and administration, shall not apply to any contracts for
any health insurance coverage, health services, or professional
services authorized to be executed under the provisions of this
article: Provided, That before entering into any such contract
the director shall invite competent bids from all qualified
entities and shall deal directly with those entities in
presenting specifications and receiving quotations for bid
purposes. The director shall award those contracts on a
competitive basis taking into account the experience of the
offering agency, corporation, insurance company or service
organization. The director may authorize or require the carrier
with whom a primary contract is executed to reinsure portions of that contract with other carriers which elect to be a reinsurer
and who are legally qualified to enter into a reinsurance
agreement under the laws of this state.
§5-16B-5. Financial plans requirements.
(a) Benefit plan design -- All financial plans required by
this section shall establish the design of a benefit plan or
plans; the maximum levels of reimbursement to categories of
health care providers; any cost containment measures for
implementation during the applicable fiscal year; and, the types
and levels of cost to families of covered children. To the
extent compatible with simplicity of administration, fiscal
stability and other goals of the program established in this
article, the financial plans may provide for different levels of
costs based on ability to pay: Provided, That the benefit plan
shall not include reimbursement for any type of abortion services
except if necessary to save the life of the mother or if the
pregnancy is the result of an act of rape or incest.
(b) Initial plan -- For presentation to the board at the
first meeting, the governor shall prepare (1) a statement of
goals and objectives of the children's health access program; and
(2) an estimate of the total amount of general and special
revenues available to fund the program for the fiscal year ending
on the thirtieth day of June, one thousand nine hundred
ninety-nine. The initial plan is subject to the following
guidelines:
(1) The board shall establish a target date for
implementation of the program during the state fiscal year one thousand nine hundred ninety-nine and may offer the same benefit
package as that offered to children of state employees insured
through the public employees insurance agency.
(2) Eligibility for the plan shall be children up to their
nineteenth birthday whose custodial parents or guardians have
income equal to or less than one hundred thirty five percent of
federal poverty. The board shall determine other eligibility
standards and criteria based on assumptions that may be
recommended by its actuary.
(3) All program costs, including the administration of the
program, including incurred but unreported claims, shall not
exceed eighty-five percent of the funding available to the
program for the state fiscal year one thousand nine hundred
ninety-nine.
(4) In lieu of the public hearing requirements of section
three of this article, the board shall afford interested and
affected persons an opportunity to offer comment on the plan at
a public meeting of the board and may solicit comments in
writing.
(c) Actuary requirements -- Beginning with state fiscal year
two thousand, any financial plan, or modifications, approved or
proposed by the board shall be submitted to and reviewed by an
actuary before final approval. The financial plan shall be
submitted to the governor and the Legislature with the actuary's
written professional opinion that all estimated program and
administrative costs of the agency under the plan, including
incurred but unreported claims, will not exceed ninety percent of the funding available to the program for the fiscal year for
which the plan is proposed; and, that the financial plan allows
for no more than thirty days of accounts payable to be carried
over into the next fiscal year. This actuarial requirement is in
addition to any requirement imposed by Title XXI of the Social
Security Act of 1997.
(d) Subsequent annual plans -- The board shall review
implementation of its initial or current financial plan in light
of actual experience and shall prepare an annual financial plan
for fiscal year two thousand and each fiscal year thereafter
during which the board remains in existence. For each fiscal
year, the governor shall provide an estimate of requested
appropriations and total funding available to the board no later
than the first day of July of the preceding fiscal year. The
board shall submit its final, approved financial plan, subject to
the actuarial and public hearing requirements of this article, to
the governor and to the Legislature no later than the first day
of January preceding the fiscal year. The financial plan for a
fiscal year shall become effective and shall be implemented by
the director on the first day of July of such fiscal year.
Annual plans developed pursuant to this subsection are subject to
the provisions of subsections (a) and (c) of this section and the
following guidelines:
(1) The board may develop and offer a benchmark-equivalent
benefit package that differs from the benefits offered in the
benchmark plan selected by the board, so long as the total
benefit package is at least actuarially equivalent to the benchmark plan.
(2) The design of the benefit package should be dollar- driven, and the aggregate actuarial value of the plan established
as the benchmark plan should be considered as a targeted maximum
or limitation in developing the benefits package.
(3) Eligibility for participation shall be children up to
their nineteenth birthday whose custodial parents or guardians
have income equal to or less than a percentage of federal poverty
established by the board, not to exceed two hundred percent of
federal poverty, and other criteria approved by the board.
(4) All estimated program and administrative costs,
including incurred but not reported claims, shall not exceed
ninety percent of the funding available to the program for the
applicable fiscal year.
(5) Defined portions of services may be provided regionally
or statewide by traditional "safety net" providers such as
community mental health centers, school health clinics, primary
care centers or rural health clinics or the board may require any
insurer or health care network providing an established set of
benefits for a set fee under the plan to contract with community
mental health centers, school health clinics, primary care
centers or rural health clinics, and other safety net county or
community facilities as may be defined by the board.
(6) The board may consider allowing families not eligible
for coverage at a subsidized cost to purchase coverage at the
full premium rate.
(7) The board may consider small employer buy-ins to the extent these may be designed to be compatible with "crowd-out"
provisions of applicable federal law that prohibit creating a
program that substitutes for group coverage.
(8) In balancing the state's interest in expanding coverage
to as many children as possible against the state's interest in
providing enhanced levels of coverage, until such time as
coverage is available to all children at less than two hundred
percent of the federal poverty level, the state's interest in
providing coverage to more children takes precedence.
(e) The provisions of chapter twenty-nine-a of this code do
not apply to the preparation, approval and implementation of the
financial plans required by this section.
(f) The board shall meet on at least a quarterly basis to
review implementation of its current financial plan in light of
the actual experience of the program. The board shall review
actual costs incurred, any revised cost estimates provided by the
actuary, expenditures, and any other factors affecting the fiscal
stability of the plan, and may make any additional modifications
to the plan necessary to ensure that the total financial
requirements of the agency for the current fiscal year are met.
The board may not increase the types and levels of cost to
families of covered children during its quarterly review except
in the event of a true emergency. The board may not expand the
population of children to whom the program is made available
except in its annual plan.
(g) For any fiscal year in which legislative appropriations
differ from the governor's estimate of general and special revenues available to the agency, the board shall, within thirty
days after passage of the budget bill, make any modifications to
the plan necessary to ensure that the total financial
requirements of the agency for the current fiscal year are met.
§5-16B-6. West Virginia CHIP fund.
(a) There is hereby created in the state treasury a special
revolving fund known as the "West Virginia Children's Health Care
Inclusion Program Fund". All moneys deposited or accrued in this
fund shall be used exclusively to provide the state's share of
the federal children's health insurance program funds,
established and maintained to purchase health services for
uninsured, low-income children; and to cover administrative costs
incurred by the board, which may not exceed ten percent of the
annual appropriation.
(b) Moneys from the following sources may be placed into the
fund:
(1) All public funds appropriated by the Legislature or
transferred by any public agency to the children's health access
program for deposit in the fund as contemplated or permitted by
applicable federal program laws;
(2) All private moneys contributed by corporations,
individuals or other entities to the fund as contemplated and
permitted by applicable federal and state laws;
(3) Any accrued interest; and
(4) Federal financial participation matching the amounts
referred to in subdivisions (1), (2) and (3) of this subsection,
in accordance with Section 1902 (a) (2) of the Social Security Act.
(c) Any balance remaining in the children's health insurance
program fund at the end of any state fiscal year shall not revert
to the state treasury but shall remain in this fund and shall be
used only in a manner consistent with this article.
(d) The fund shall be administered by the board, through its
director, or, until such time as the director assumes the duties
of the office, by the commissioner of the bureau of medical
services. Moneys shall be disbursed from the fund on a quarterly
basis. The secretary of the department of health and human
resources, in the name of the board, shall submit and receive
approval of the state's children's health access plan in
accordance with the provisions of Title XXI of the Social
Security Act of 1997 prior to the receipt of any transfer or
contribution from any public or private source.
(e) All moneys expended from the fund after receipt of
federal financial participation shall be allocated to
reimbursement for health services provided in accordance with the
approved plan and the administrative costs as set forth in this
article. Expenditures from this fund for any other purposes are
void.
§5-16B-7. Termination and reauthorization.
(a) The children's health insurance program established in
this article abrogates and is of no further force and effect,
without any further action by the Legislature, upon the earliest
of the following dates:
(1) The date upon which a reduction in the level of federal funds becomes effective
for children's health insurance programs
created by federal law under Title XXI of the Social Security Act
of 1997
, below amounts allocated to the state
in the year one
thousand nine hundred ninety-nine and below future year
reductions contained in the original enactment by the Congress
of
Title XXI of the Social Security Act of 1997
: Provided, That if
an act reducing such funds specifies a date later
than the
effective date of the legislation on which the reduction of funds
takes effect, that later date controls.
(2) The date upon which a judgment or order of a court of
competent jurisdiction becomes final disallowing the state plan
for a children's health access program established by the board
under this article.
(3) The date upon which any federal administrative rule or
regulation promulgated in conformity with federal law becomes
effective which negates the effect or purposes of this article:
Provided, That if such rule or regulation specifies a later date
on which the prohibition takes effect, that later effective date
controls.
(b) Pursuant to the provisions of article ten, chapter four
of this code, the board shall terminate on the first day of July,
two thousand four, unless extended by legislation enacted before
the termination date.
(c) Upon termination of the board and notwithstanding any
provisions in this article to the contrary, the director of the
children's health access program is authorized to change the
types and levels of costs to the families of enrollees, within the limits permitted by applicable federal law, only in
accordance with this subsection. Any assessments or changes in
costs imposed pursuant to this subsection shall be implemented by
rules of the director proposed to the legislature pursuant to the
provisions of chapter twenty-nine-a of this code. Any costs
authorized by the board shall remain in effect until amended by
rule of the director promulgated pursuant to this subsection.
§5-16B-8. Preparation of state plan.
Upon the effective date of this article, the secretary of
the department of health and human resources shall make available
to the children's health access program staff of the department
to prepare at the direction of the board, and in the name of the
board, the state Title XXI plan required by applicable federal
law, to include those descriptions, procedures and proposals for
implementation under this article and article four-a, chapter
nine of this code, that will serve to qualify the state's program
for children's health insurance for approval by federal
authorities.
CHAPTER 9. HUMAN SERVICES.
ARTICLE 4A. MEDICAID UNCOMPENSATED CARE FUND.
§9-4A-2b. Expansion of coverage to children and terminally ill;
West Virginia children's health care inclusion
plan.
(a) It is the intent of the Legislature that steps be taken
to expand coverage to children and the terminally ill and to pay
for this coverage by fully utilizing federal funds. To achieve
this intention, the department of health and human resources shall undertake the following:
(1) Effective the first day of July, one thousand nine
hundred ninety-four ninety-eight, the department shall initiate
a streamlined application form, which shall be no longer than two
pages, for all families applying only for medicaid medical
coverage for children under any of the programs set forth in this
section.
(2) Effective the first day of July, one thousand nine
hundred ninety-four, the department shall initiate the option of
hospice care to terminally ill West Virginians who otherwise
qualify for medicaid. On or before the first day of January, one
thousand nine hundred ninety-five, and periodically thereafter,
the The department shall report report quarterly to the
legislative task force on uncompensated health care and medicaid
expenditures oversight commission on health and human resources
accountability created pursuant to section four, article
twenty-nine-c twenty-nine-e, chapter sixteen of this code
regarding the program initiation provided for in this
subdivision. The report shall include, but not be limited to,
the total number, by age, of newly eligible clients served as a
result of the initiation of the program pursuant to this
subdivision, the average annual cost of coverage per client, and
the total cost, by provider type, to serve all clients.
(3) Effective the first day of July, one thousand nine
hundred ninety-four, the department shall accelerate the medicaid
option for coverage of medicaid to all West Virginia children
whose family income is below one hundred percent of the federal poverty level. On or before the first day of January, one
thousand nine hundred ninety-five, and periodically thereafter,
the The department shall report provide quarterly reports to the
legislative task force on uncompensated health care and medicaid
expenditures oversight commission on health and human resources
accountability regarding the program acceleration provided for in
this subdivision. The report shall include, but not be limited
to, the number of newly eligible clients, by age, served as a
result of the acceleration, the average annual cost of coverage
per client and the total cost of all clients served by provider
type.
(4) Effective the first day of July, one thousand nine
hundred ninety-five ninety-eight, the department may initiate the
medicaid option to shall expand medicaid coverage
of medicaid to
all for only those West Virginia children below the age of six
years whose family income is below one hundred thirty-three fifty
percent of the federal poverty level. This program will be known
as "mini-CHIP" and administered in accordance with the applicable
provisions contained in Titles XIX and XXI of the Social Security
Act. The department shall coordinate the eligibility
determination, outreach efforts, purchasing strategies, service
delivery system and reporting requirements with the "CHIP"
program created pursuant to provisions of article sixteen-b,
chapter five of this code. To prepare for program expansion the
department shall submit a report to the governor and the
Legislature on the first day of January, one thousand nine
hundred ninety-five, regarding the feasibility of the expansion. The report is to include, but not be limited to, the number of
newly eligible clients participating in the programs specified in
this section, the average annual cost of coverage per client, the
percentage of expected participation for the expansion, the
projected cost of the expansion, the medical services trust fund
balance and the future disproportionate share
moneys expected to
be deposited in the medical services trust fund pursuant to
section two-a of this article . The department shall continually
update the additional information required to be provided to the
governor and the Legislature regarding this expansion and
periodically report the information to the legislative task force
on uncompensated health care and medicaid expenditures created
pursuant to section four, article twenty-nine-c, chapter sixteen
of this code.
(5) Effective the first day of July, one thousand nine
hundred ninety-six, the department may initiate the medicaid
option to expand coverage of medicaid to all West Virginia
children whose family income is below one hundred fifty percent
of the federal poverty level. To prepare for program expansion,
the department shall submit a report to the governor and the
Legislature on the first day of January, one thousand nine
hundred ninety-six, regarding the feasibility of the expansion.
Additionally, the report is to include, but not be limited to,
the number of clients who would be newly eligible to participate
in the program, the average annual cost of coverage per client,
by age, the percentage of expected participation for the
expansion and the projected cost of the expansion, the balance of the medical services trust fund and the future disproportionate
share moneys expected to be deposited in the medical services
trust fund pursuant to section two-a of this article. The
department shall periodically update and report to the
legislative task force on uncompensated health care and medicaid
expenditures created pursuant to section four, article twenty- nine-c, chapter sixteen of this code regarding the additional
information required to be submitted to the governor and the
Legislature.
(b) Notwithstanding the provisions of section two-a of this
article, the accruing interest in the medical services trust fund
may be utilized to pay for the programs specified in subdivisions
(2) and (3) of subsection (a) of this section: Provided, That to
the extent the accrued interest is not sufficient to fully fund
the specified programs, the disproportionate share hospital funds
paid into the medical services trust fund after the thirtieth day
of June, one thousand nine hundred ninety-four, may be applied to
cover the cost of the specified programs. Provided, however,
That in fiscal year one thousand nine hundred ninety-five, the
amount of funds applied from the disproportionate share funds,
not including accrued interest, shall not exceed ten million
dollars: Provided further, That in the interest of fiscal
responsibility, the department shall terminate the program
specified in subdivisions (4) and (5) of subsection (a) of this
section, if the future moneys deposited from disproportionate
share payments in the medical services trust fund are
insufficient to cover the cost of the expanded program.
(c) On the first day of January, one thousand nine hundred
ninety-five and annually thereafter, the department shall report
to the governor and to the Legislature information regarding the
number of children and elderly covered by the program programs in
subdivisions (2) and (3) of subsection (a), the cost of services
by type of service provided, a cost-benefit analysis of the
acceleration and expansion on other insurers and the reduction of
uncompensated care in hospitals as a result of the programs.
(d) On the first day of January, one thousand nine hundred
ninety-nine and annually thereafter, the department shall report
to the governor and to the Legislature information regarding the
number of children enrolled in the medicaid program resulting
from the "outreach program"; the number of children enrolled in
"mini-CHIP"; the estimated number of children eligible for
enrollment in either program; the cost of services by type of
service provided in both programs; an analysis of the impact of
the programs on other insurers; and the reduction of
uncompensated care in hospitals as a result of the programs. The
annual report filed by the department shall also include
information relating to any proposed expansion of the population
to be served under the state's medicaid program, other than the
expansions specifically authorized in this section, and any
expansion in the population to be served may not be implemented
until sixty days following the filing of the report required in
this subsection.
The department shall make quarterly reports to
the legislative oversight commission on health and human
resources accountability, established pursuant to section four, article twenty-nine-e, chapter sixteen of this code regarding the
development, implementation and monitoring of the program.
(d) The health care cost review authority established by
section five, article twenty-nine-b of this chapter shall
consider in its rate review that uncompensated care and charity
care are reduced by the programs specified in subsection (a) of
this section and shall take the reduction into account when
determining rates. This determination shall be undertaken in
each hospital's next rate review and shall be determined
prospectively.
(e) On the first day of January, one thousand nine hundred
ninety-five, and annually thereafter, the health care cost review
authority shall present to the governor and to the Legislature a
report concerning the reduction in cost shift created by the
operation of the provisions of this article.
(f) The department shall review the additional utilization
by behavioral health centers as a result of the acceleration and
expansion for a period of eighteen months from the enactment of
this article: Provided, That during the eighteen-month study
period the department shall not issue additional behavioral
health licenses: Provided, however, That this license provision
does not apply to facilities filing for renewal applications or
to any health care facility which has a certificate of need in
effect or an application pending on the first day of March, one
thousand nine hundred ninety-four: Provided further, That this
licensure prohibition shall not apply to behavioral health
services provided pursuant to any agreement for state owned psychiatric hospitals which are approved by the federal health
care finance administration.
§9-4A-3. West Virginia mini-CHIP fund.
(a) There is hereby created in the state treasury a special
revolving fund to be known as the "West Virginia mini-CHIP Fund",
which shall be an interest-bearing account established and
maintained to purchase health services for low-income children.
(b) Funds paid into this account shall be derived from the
following sources:
(1) Any appropriations by the Legislature;
(2 All public funds transferred by any public agency as
permitted by applicable federal law;
(3) Any private funds contributed, donated or bequeathed by
corporations, individuals or other entities to the fund as
contemplated and permitted by applicable federal law; and
(4) All interest or return on investments accruing to the
fund.
(c) Moneys from this fund shall be used exclusively for the
following purposes:
(1) To purchase health care services for the program
defined in subdivision (4), subsection (a) of this section,
associated administrative costs, outreach activities and
eligibility determination costs; and
(2) To provide the state's share of the enhanced federal
medical assistance percentage funds.
(d) Notwithstanding the provisions of section two, article
two, chapter twelve of this code, moneys with the mini-CHIP program may not be redesignated for any purpose other than those
set forth in this subsection.